I really need to see that episode of South Park for myself.
If only it weren’t illegal I’d ask somebody to burn me a dvd and mail it to me.
(Preliminary note of thanks for having this conversation with me. Reading my posts, I seem, even to myself, like the most obtuse or confrontational person in the world, but thanks for taking my questions in the spirit of good-faith in which they were intended.)
Well, let me rephrase. “Does it work?” seems to be a great standard for therapy, but I don’t see a “No” answer as suddenly meaning, “Welp, the brain is right and the genitals are wrong,” as weirddave asked. To me, ineffective therapy simply means that the therapy didn’t work, not that it validated the belief of the brain over the dictates of the chromosomes. To put it another way, I don’t see how you turn “Therapy don’t work” into “So the brain is right and the body is wrong.” I see it as “So that line of therapy sucked for that person in that case.” Dave’s question still stands, AFAICT.
Well, if therapy can indeed work, why did you state “…treating transexuality strictly through therapy just doesn’t work”? It seems better to say, “Addressing transexuality issues with therapy is bloody hard.”
And if therapy can indeed work, what ramifications does that have on people who say, “Look, I’ve got a body that doesn’t match my brain”? Is the only appropriate answer, “You’re right”? Or is it equally appropriate to say, “That sucks, but hopefully psychology can help. You don’t need surgery”? Am I being hateful if I take the latter approach?
“Do not respond to psychological treatment,” or “Haven’t responded yet”?
Look, if the answer is “Therapy may work, but surgery almost certainly will,” then fine. But if that’s true, I don’t want to be called hateful for thinking that the problem is psychological and “Deal with who you are” is an acceptable (albeit simplified) solution.
Why is this belief exclusive to the transgendered? Why can it not also apply, potentially, to Kyle, for whom whiteness is just “wrong”? Or, to use a slightly less silly example noted in the old thread linked to above, what about people who deliberately cut off limbs, because being armless is “right”?
Therapy may work for an individual with Gender Dysphoric Disorder. It may be possible to cure a manic depressive with a sugar pill. It may also to cause a patient’s malignant tumor to entirely vanish by singing Barry Manilow. That’s what is meant by not absolute. But in the overwhelming majority of cases, therapy doesn’t cure GDD, manic depression needs lithium carbonate, and tumors don’t vanish because of Copa Cabana.
‘Medicine is not absolute’ means that you can’t make flat, general statements and be accurate. But you can say that certain things are true almost all the time. It isn’t “bloody hard” to treat GDD with therapy. At least 90% it just doesn’t work. Therapy, along with hormone replacement and eventually sexual reassignment surgery is the recommended course of treatment.
Re Brain Vs Chromosomes
http://www.gires.org.uk/Text_Assets/maletofemale.pdf Warning PDF
Short version- there’s statistically significant evidence that transfolk really are born with a brain sex conflicting with their body. The Stria Terminalis of mtf patients more closely resembles that of natal women than that of natal men. The ST is not effected by the hormonal therapy used by mtf patients.
Chromosomes can conflict with the genitalia. For example, in Androgen Insensitivity Syndrome you get a person who has XY genes, a female brain, and a vagina.
RE Kyle
You show me first how a black brain is different from a white one. Second, a proven case of a white brain in a black body or vice versa.
Re Apotmenophilia
Again, an amputee’s brain is no different from that of a fully assembled person.
I’m not sure what the success rate is for cancer, but presumably, at some narrow window in human history, one could have said, “90% of the time, we just cannot cure cancer.” Does that mean that cancer, during that narrow window, was incurable, and the recommended course of treatment was cisplatin and funeral arrangements? Or does it mean that more successful “cures” for cancer had not yet been achieved?
Might not the same be said for therapy wrt GDD? Currently, the success rate is 10%, but that yet-to-be-uncovered treatment of magnets and hypnosis and whatnot may address that? Why throw up your hands and declare therapy all but useless for “treating” those with GDD?
Well, without access to the full article, I can’t state how well this study addressed other possible causes of variation – race, size, diet, other physiological defects, etc., although I hope that the researchers would have accounted for those. (And some of them might just be non-factors; I’m not a neurologist.) But I did note that there was only one “transman” and that “the neuron number of a transman [FtM] was found to be in the male range.” That’s a fairly vague statement, and I’m wary of drawing any conclusions whatsoever from a sample size of one.
But you’re essentially saying that there’s scientific evidence that brain and body may not match, which seems to be a good answer to me. In your opinion (I assume you’re a doctor of some sort), is the “jury still out” on the idea, or is it pretty much accepted?
Cite? I note that Wikipedia says, “The biological theory is that BIID [Body Integrity Identity Disorder, nee Apotemnophilia – aliquot] is a neuro-psychological condition in which there is an anomaly in the cerebral cortex relating to the limbs.” Besides, I’m just amazed that someone has done a brain study, with CAT scans or dissections or whatever, and said, “Nope, they’re the same.”
I think it’s a mistake to get hung up on epistomological questions like, “Is the brain right and the body wrong?” Who gives a shit? If therapy isn’t making you a healthier, happier person, and surgery will, go with the surgery. The point of therapy is not to make someone conform with what we think he or she should be, it’s to make the patient capable of living a healthy, happy, functional life. Whatever approach is most likely to give that result, is the best approach to use.
Because my original statement is still functionally true. Therapy doesn’t cure transexuality. It can identify someone’s gender identity confusion as something other than transexuality, and it can determine that someone is transexual, but doesn’t necessarily need to transition, but it cannot erase the underlying disconnection between external and internal gender. So far as science has been able to determine, gender identity is entirely immutable. There may be some exceptions to this: there are always exceptions. But they’re rare enough as to be statistically negligible.
Further, if we’re talking specifically about people who have already undergone SRS, then by definition, their problem is not treatable through therapy, as a minimum of one year of therapy is a prerequisite for qualifying for SRS in the first place.
If someone comes to you saying they’ve got acute abdominal pains, and they think they might have appendicitus, do you tell them that they don’t need surgery, because maybe it’s just stomach gas? Of course not. You’re not a doctor. In particular, you’re not they’re doctor. So why would you think it’s your place to tell them what treatments they may or may not need?
“Do not respond.” Ever. At all. In any way.
Out of curiosity, what would be your response to someone claiming to suffer from clinical depression? Would you tell them to “just snap out of it?”
Setting aside for a second that Kyle’s affliction does not exist in the real world, who says that it shouldn’t apply to him? If there were a significant population of people who felt that they should have been born to a different race, who were unable to find happiness or personal satisfaction while being perceived to be the “wrong” race, and who had access to a surgical process that could make them appear to be a member of their desired race, would anyone (other than racist idealogues) demand that they not be allowed that treatment?
Because being armless is a serious, debilitating condition. Being a woman, is not.
We know that the overwhelming majority of the time, therapy doesn’t work. How do we know? Studies, data, the usual. There may in the future emerge some treatment that works. But for now, therapy, hormones, and SRS get the best results.
One of my bookmarks is gone. I had a link to an attack on the study and a refutation. AFAIC the case is proven.
That would actually be an extremely wide window in human history, consisting of pretty much all of it prior to the 20th century.
Define “succesful,” as regards to treating transexuality.
Currently, thanks to SRS, the success rate for treating transexuality is significantly higher than 10%. And, of course, no one has given up on finding new ways to treat it. The best approach would probably be preventative, pre-natal care, assuming we can figure out why it happens in the first place, and how to diagnose it. But, sure, maybe in the future, we’ll find some other cure. That doesn’t change the fact that we don’t have one right now, and that the people suffering from transexuality right now can’t wait around on the off-hand chance that some miracle break through will occur during their lifetimes.
I’m not going to be able to respond point-by-point (the guilt of hijacking this poor thread has finally caught up with me), but you both make some salient points. In an attempt to steer the conversation back to an at least marginally related to… well, not the first post, but an early post ;), I’d like to comment on:
I agree with this entirely (except for the part about “a significant population” – what sort of a quorum is needed?), which is why I found the analogy made in the controversial episode of South Park to be apt. Which, in turn, is why I found it so puzzling that a number of people wrote off the episode and this comparison as insulting or hateful. Overly simplified? Yeah, no sweat, that’s what P&S do – take a complicated issue and, often aided by strawmen and poor logic – make it a clear-cut issue that can be summarized by a cardboard cutout of an eight-year-old in three sentences. But hateful??
(P.S. No, a 90% failure rate for cancer cures would be a pretty narrow window, I should think. Prior to the middle of the 20th Century, the failure rate for cancer cures was 100%. I imagine it’s less than 90% today.)
I haven’t seen the episode myself, so I’ve tried not to comment on it, but I suspect a lot of the negative reaction was due to a condition that is devastating to a lot of people being trivialized by comparison to a patently ridiculous invented pathology, and then using that comparison to “prove” that transexuality isn’t a “real” problem. Not having seen it, I don’t know how hatefully this point was made. I do think it’s rather telling that when they decided to make fun of homosexuality, they introduced a new character (Big Gay Al) who, although very stereotypical, was ultimatly shown to be a sympathetic character with valid concerns. When they wanted to make fun of Mormonism, they introduced a character who, although very stereotypical, was ultimatly shown to be a sympathetic with a valid (if historically suspect) belief system. When they wanted to make fun of transexuals, they introduced… Mrs. Garrison, and ended with a homily that cavalierly dismissed the entire concept of transexuality.
I was factoring in benign tumors, and the like. Even untreated, cancer isn’t always fatal.
Of course not, but that doesn’t mean it was “cured” through human action. Thus, 100% of cancer cures were failures until the 19X0s.
This is incorrect. The prerequisite is that the patient must live full-time in the destination gender for one year before qualifying for SRS. The length of therapy is not specified, but presumably would be much longer than one year in most cases.
And, Miller and aliquot, as the OP I’d rather you two start a new thread in GD or IMHO if you want to continue this. Please leave this thread to its own purpose.
While undergoing therapy.
Hence “at least.”
Sorry.
There’s no specific requirement as to the number of hours of therapy or over how long a period. Theoretically I could have gotten my “hormone letter,” gone full-time, and then gone back to my therapist a year later for my “surgery letter” without any visits in between.
Hey, but clearly you know more about this sort of thing than I do.